Mitral Valve Plasty for Mitral Regurgitation in Hypertropic Obstructive Cardiomyopathy

(Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan)

Satoshi Hoshino Toshiaki Ito Atsuo Maekawa
Sadanari Sawaki Genyo Fujii Yasunari Hayashi
Mitral valve replacement(MVR)is an effective method to treat mitral valve regurgitation(MR)associated with hypertrophic obstructive cardiomyopathy(HOCM)because of systolic anterior movement(SAM)of anterior leaflet. We retrospectively investigated results of mitral valve surgery concomitant with septal myectomy for MR with HOCM. Between August 2008 to July 2009, 7 patients underwent septal myectomy. Among them, 6 patients who had moderate or severe MR preoperatively were objects of this study. Pre and post operative clinical conditions, findings of echocardiogram, and operative techniques employed in each patient were reviewed. Four patient successfully underwent mitral valve plasty(MVP)with septal myectomy. One patient needed only septal myectomy because MR subsequently disappeared with resolution of SAM. One patient resulted in MVR after attempted mitral valve plasty(MVP). SAM disappeared in all patients who had MVP, and residual MR was mild or less. Pressure gradient of left ventricular outflow significantly decreased in all cases. All patients discharged hospital uneventfully. Plication of posterior leaflet, anterior leaflet augmentation if necessary, and prudent use of annuloplasty ring seemed to be effective for successful MVP in HOCM patients. MVP is feasible even in patients with MR derived from HOCM.
  Jpn. J. Cardiovasc. Surg. 42:1-5(2013)

Keywords:HOCM, myectomy, MR, MVP